I have an appointment with my cardiologist in about 5 weeks time and I am considering asking if I can go down the Pill in the Pocket route.

I was in persistent AF last year but after 6 months on Amiodorone I was back in NSR. I have 2 AF episodes since I came off the Amiodorone (approx 6 months ago) one of which lasted 8 hours and stopped by itself and the other I was chemically cardioverted using Flecainide. I currently take 50mg Flecainide twice a day as well as Rivaroxaban and Bisoprolol.

Anyway, when I go into AF, I don't really get what could be described as acute symptoms. My resting heart rate is usually 50-60 and during AF goes up to 80-100. I can carry on my usual day with just a little discomfort and only usually end up in hospital as I don't know what else I am meant to do.

I don't like taking the Flecainide as I get side effects of chest discomfort and the Bisoprolol makes me feel lethargic all the time.

So with this in mind I want to ask my cardiologist if I can try the PIP approach so that when I next go into AF I can take some Flecainide to revert back to NSR.

Does anyone else use this method already? If so do you have any advice?

Last time i was in hospital, one of the cariologist doing the ward rounds was talking about an ablation. I really don't want to go down this route yet as it seems extreme considering that I'm not really suffering too badly!!!

7 Replies

Yes I used PIP with flecainide when I first started my AF journey ten years ago. It worked for a while. You must understand that AF is almost always progressive so this approach may well not control your condition for very long if at all but if you want to try it then why not?

Regarding ablation, this is an old chestnut and whilst most experts agree that early intervention by ablation stands the best chance of a good long term outcome, patients always seem to be overly concerned. Yes there are risks but often overstated apparently. We are a very litigious society these days so doctors have to tell you every possible combination of risks to safeguard themselves against law suits. There are risks in doing nothing of course but these are seldom explained. You can probably tell that I am a fan of ablation having had three and no AF for many years now. It has been said that you will know when you are ready even if that is too late!

Two amusing stories. If you are being chased by a lion towards a river full of crocodiles, there comes a point when the crocs look the best bet.

A man is standing on a river bank. In front of him is a mine field, behind are crocodiles. A general cardiologist and an electrophysiologist appear and the cardiologist tells him that he knows a good route through the mine field. The EP then produces a rifle and tells him that he can shoot all the crocs and he can cross the river that way. Oh do be careful says the Cardiologist. Sometimes he misses.

Like I say it is a minefield and when you are ready you will know but do read as much as you can as knowledge is power.

After two unsuccessful ablations and then being told my heart is too scarred inside to have another, I have used Flecainide and a quarter of Metoprolol as PIP for the last year and it has been like a miracle cure for my PAF. I was advised to take the small dose of beta-blocker (Metoprolol) to prevent my heart from going into atrial flutter when using Flecainide alone.

Like you, I don't feel too out of gear when AF strikes. It gets me about once in 6 weeks and is not a lot of bother. I'm aware that my heart isn't behaving but I can carry on. It's no big deal and usually goes away and if it doesn't I'll take flecainide and it works. I've taken 50mgs of flecainide perhaps eight times in the past 14 months.

It's better, I believe, to control AF so that it doesn't happen because it takes a toll on the left atrium in particular, so a daily maintenance dose of flecainide that keeps AF away is preferred. I've had two ablations and am very happy - over the moon - to be where I am now because I'm a lot better off than I was. I was getting far more AF than I have now and I was on 300mgs of flecainide a day.

We have to balance the damage AF causes against what flecainide does to you. It's made my feet numb and I'd be very reluctant to take it on a daily basis again. Thus I I'm almost certainly opting for a third ablation because to be AF free has to be better than having it and controlling it either with a daily dose or a PIP, even if it's not that intrusive. I've been on my EP's waiting list for a while and have to say yea or nay in the near future. If an ablation is offered, why say no? There are small risks, but the gain can be huge.

My thoughts and feelings are to start down the ablation route earlier rather than later as you want to get treatment before you get to the persistent AF stage. The chances of success are much higher if someone is in paroxysmal AF rather than persistent. It will take months and if the EP (make sure you get referred to an EP who is on the AFA's list) and if you are not ready then you will be on the back burner so to speak. Also as I understand it from reading and discussions the medicines don't stop the AF developing just hold the heart in NSR and make you less symptomatic and have a better QoL.

I agree with the comments above, particularly two important points. Firstly, even if PIP does the trick initially, it will almost certainly cease to be effective over a period of time - it may not last a year. Secondly, if you are capable of being cardioverted to NSR, which you clearly are, then an ablation, the only thing close to a cure for AF, is available to you.

No matter how few symptoms you get with AF now, they are likely to worsen in time - you know that.

Thank you all for your comments. I guess I am scared of an ablation as the cardiologist who mentioned it said there is a 2% chance of it going wrong. Then another guy on the same ward as me said that if they tear the heart membrane between the chambers, they need to urgently open you up for heart surgery!!!